NEWS BRIEFINGPopulation Health Strategies

moderated by:

David G. Marrero, PhD

University of Arizona Health Sciences

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EMBARGO POLICY

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• Information presented today in this briefing is under embargo until the end of the formal scientific presentation here at the conference.

• Please consult the top of each press release for embargo dates and times.

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Mental Health Disorders and

Diabetes Distress Among

Adults with Diabetes

Symposium Summary

Mary Beth Weber, PhD, MPH

Emory University

Presenter Disclosures

• Nothing to disclose

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Symposium Speakers

• Dr. Mary de Groot: The Epidemiology and Impact of Mental Health Disorders among Adults with Diabetes

• Dr. John W. Newcomer: Diabetes among Patients with Complex Mental Health Disorders and with Use of Antipsychotic Medications—Implications for Screening and Management

• Dr. Mark D. Williams: Caring for the Whole Patient—Best Practices for Managing Mental Health Disorders and Diabetes

• Dr. Kathryn Evans Kreider: Diabetes Distress—Epidemiology, Impact, and Treatment

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Mental Health

Depression

Anxiety Disorders

Diabetes Distress

Eating Disorders

Diabetes

Biology

Behavior

Treatments

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Diabetes and Mental Health Disorders

• Further complicate diabetes management

• Affect mental health presentation

• High rates of cardiometabolic risk factors

• Higher rates of severe secondary complications

• High cost (monetary, time) of managing two chronic disorders

• Premature mortality

• Higher rates of functional disability

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Diabetes and Severe Mental Illness

• Antipsychotic medications further increase risk

• Less likely to screened or treated for hyperglycemia

• Less likely to receive the most effective care if they have a cardiovascular event

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Diabetes Distress

“ …Diabetes distress (DD) refers to the emotional distress associated with the ongoing worries, burdens and concerns that occur when managing a demanding chronic disease like diabetes over time.”

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Poor self care behaviors, low diabetes self-efficacy,

and lack of adherence

Fisher, Gonzalez, & Polonsky, 2014

Caring for Patients with Diabetes and

Mental Health Disorders

• Care is often in silos

• Primary care providers have limited per patient time

• Delays in getting psychiatric care

• Shortage of psychiatrists

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Alternative Models are Needed

• Good evidence for improvement:

o Screening/testing reminders for physicians

o Psycho-Education of patients

o Psychiatrists co-located with primary care

o Care Coordinators

o Team care model/Collaborative care model

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What is needed?

• More research on mental health disorders, diabetes distress and

diabetes, particularly:

o Finding the best models of care

o In children

o In low- and middle-income countries

• Better whole-patient care

• Reduction of stigma of mental health disorders

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Research Perspectives on

Depression and Diabetes

The Stress Hormone Link

Sherita Hill Golden, MD, MHS, FAHA

Johns Hopkins University School of Medicine

Hugh P. McCormick Professor of Endocrinology and Metabolism

Executive Vice-Chair, Department of Medicine

Presenter Disclosures

• Nothing to disclose

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Diabetes and Depression:

A Common Association in Adults

• Aggregate odds ratio of depression in adults with diabetes

compared to those without diabetes: 2.0 (95% CI: 1.8, 2.2)

• Lifetime prevalence of major depression higher in individuals with

diabetes (17.5%) compared to those without diabetes (6.8%)

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Anderson et al. Diabetes Care, 2001

Traditional Approach to Considering

Pathogenesis: Direction of Association

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Diabetes mellitus Psychosocial

HyperglycemiaDEPRESSION

Diabetes Predicts Development of Depression

• Individuals with diabetes at baseline had a 50% higher risk of

developing depression during follow-up compared to those without

diabetes

• Independent of differences in diabetes complications,

socioeconomic status, and obesity

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Golden et al, JAMA, 2008

Depression

DIA

BE

TE

S

ME

LL

ITU

S

Interrelated biological pathways• Stress hormone axis dysfunction

• Inflammation

• Disrupted circadian (sleep) rhythms

Obesity-promoting

Health Behavior

Treatment-related

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Depression Predicts Development of Diabetes

• Depression was associated with type 2 diabetes risk factors:

o Less physical activity

o Greater calorie intake

o Higher likelihood of current smoking

o Higher body mass index

o High levels of inflammatory markers

• After controlling for these factors, depression was

associated with a 21% higher risk of developing

type 2 diabetes

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Golden et al, JAMA, 2008

Multi-Ethnic Study of

Atherosclerosis

Innovative Approach to Depression-Diabetes

Association: Shared Risk Factors (“Common Soil”)

• Overt hypercortisolism – leads to development

of type 2 diabetes and depression (e.g.,

Cushings’ Syndrome)

• Shared risk factor hypothesis

faculty.plattsburgh.edu Holt RIG, Diabetes Care, 2014

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So what? Significance and Future Directions

• Modification of the cortisol stress response: a novel approach to primary prevention of Type 2 diabetes (complementary to established measures)

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Multi-Ethnic Study of

Atherosclerosis

• Collaborative care models that simultaneously treat depression and diabetes will likely improve outcomes for both conditions

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247-OR

Diabetes Risks in U.S. Asian Indian Immigrants

Impacted by Adopted Lifestyle Habits

Nitha Mathew Joseph, PhD, RN

University of Texas Health Science Center at Houston

Assistant Professor, Cizik School of Nursing

Presenter Disclosures

• Nothing to disclose

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Reason for Study

• Asian Indians are the second largest and fastest growing Asian-American groups (3.19 million) in U.S.

• Greater risk for morbidity and mortality from diabetes and cardiovascular diseases (CVD) than Caucasians and other immigrants in the U.S.

o Lower rates of participation in physical activity

o Unhealthy eating habits

• Acculturation-related adopted lifestyle habits increase risks for obesity, diabetes and cardiovascular diseases (CVD)

o NO national study among Asian Indians

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Study Goal

• Examined the role of life style behaviors,

specifically physical activity and dietary

behaviors, for increasing the risk for

diabetes and cardiovascular diseases

due to acculturation in Asian Indians

using Diabetes in Asian Indians (DIA)

national study data

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Risk for Diabetes and CVD

Acculturation

Physical Activity &

Dietary Behaviors

Methods

• National Study: Seven U.S. urban sites

• Sample size: 1,038 adult Asian Indians (average age, 48.5 years)

• Physical activity and dietary behaviors: Revised Health Promotion Lifestyle, Profile II

• Acculturation: Language proficiency subscale of the Acculturation Scale for Southeast Asians

• Risks for diabetes and cardiovascular diseases: BMI, blood pressure, fasting blood sugar, glycosylated Hemoglobin (HbA1c) and lipid profiles

• Analysis: Descriptive statistics and path analysis

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Results

• Healthy dietary behavior influenced the association between

acculturation and HbA1c levels.

• Physical activity influenced the association between acculturation

and HDL levels.

• Dietary behavior and physical activity did not influence the

relationship between acculturation and many of the other risk

factors for diabetes and heart diseases.

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Summary and Conclusions

• Additional research needed to understand the mechanisms by which acculturation affects other cardiometabolic risk factors such as:

o Smoking

o Alcohol

o Psychosocial factors

o Abdominal obesity

• Designing culturally tailored dietary education and physical activity:

o Promote positive lifestyle changes

o Reduce and/or prevent diabetes and heart disease

• Reduce the health and economic burden with these conditions.

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Preventing Type 2 Diabetes Through Lifestyle:

The National Diabetes Prevention Program

Ann Albright, PhD, RDN

Centers for Disease Control and Prevention

Presenter Disclosures

• Nothing to disclose

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National Diabetes Prevention Program (DPP)

• The largest national effort to mobilize and bring effective lifestyle

change programs to communities around the country!

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National DPP Strategic Goals

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Increase the

supply of quality

programs

Increase

coverage among

public and

private payers

$Coverage &

Reimbursement

Increase

referrals from

healthcare

providers

Increase demand

for the National

DPP among

people at risk

Demand From Participants

Referrals

Quality Programs

Coverage for Public Employees

• Over 3.4 million public employees and

dependents in 18 states have the National

DPP lifestyle change program as a

covered benefit

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RI

States with Coverage for

State/Public Employees

• California

• Colorado

• Connecticut (DOT workers)

• Delaware

• Georgia (Kaiser members)

• Kentucky

• Louisiana

• Maine

• Maryland (partial payment)

• Minnesota

• New Hampshire

• New York

• Oregon (educators/local government)

• Rhode Island

• Tennessee

• Texas

• Vermont

• Washington

Demonstrations ongoing in North Dakota, Pennsylvania, South Dakota,

and Utah

Medicare Diabetes Prevention Program

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Phase 1 - CMMI Authorization to Evaluate Innovative Payment Techniques

• CMMI conducted a model test of Medicare participants in the Y-DPP and found substantial cost savings

per participant (2012-2015)

• HHS Secretary announced that Medicare will cover the National DPP lifestyle change program for eligible

Medicare beneficiaries (March 2016)

• First time that both traditional healthcare providers and community-based organizations can enroll as

Medicare suppliers to deliver a preventive service

Phase 2 - Rule-Making Process

• First final rule established the MDPP Expanded Model (Nov. 2016)

• Second final rule established policies related to beneficiary eligibility, payment structure, and supplier

enrollment/program integrity requirements (Nov. 2017)

Phase 3 - Implementation

• CDC-recognized organizations began enrolling as Medicare DPP (MDPP) suppliers on January 1, 2018

• MDPP suppliers began offering MDPP services to Medicare beneficiaries on April 1, 2018

• CMS established an MDPP Help Desk (1-877-906-4940 or mdpp@cms.hhs.gov)

• CDC established a Customer Service Center (July 2018)

Medicaid Coverage – Work with Partners

• Goal: Achieve sustainable coverage of the National DPP lifestyle change program for Medicaid beneficiaries • Result: Remove cost barriers and reduce diabetes health-related disparities for high-risk, high burden populations

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• Work with State Health Departments – Funded health departments in all states and DC to partner with their Medicaid sister agencies to make the case for coverageo 9 states have full or partial coverage through Medicaid authorities, demonstrations, or pilots

– Statewide coverage in place or in process: CA, MN, MT, NJ, VT– Demonstration projects in process: AR, MD, OR, PA

• Work with National Organizations – Funded ten national organizations to establish new programs through affiliate sites in underserved areas to reach priority populations

• Work with Managed Care Organizations (MCOs) – Funded a comprehensive Demonstration Project with MCOs in MD and CCOs in OR with a focus on implementation and uptake:o Screened, tested, referred, and enrolled almost 1,000 participants in both in-person and virtual programso Implemented a value-based coverage and reimbursement modelo Supported by an Expert Panel of representatives from all major Medicaid MCO national organizations

• Products/Outcomeso Virtual Learning Collaborative with 20 Stateso National DPP Coverage Toolkit: https://coveragetoolkit.org/ o Final Demonstration Project Evaluation Report (Oct. 2018)o New Tools and Resources for the National DPP Customer Service Center: https://nationaldppcsc.cdc.gov

EMBARGO REMINDER

• Any reporters in violation of the embargo policy will be barred from

this and future Scientific Sessions.

• For interviews with any of the presenters, please contact Michelle

Kirkwood or a member of the Press Office team.

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MEDIA CONTACT

On-site Press Office – Room 109B

Press@diabetes.org

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